Carletta Annyse Demetree, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

107002 Issued in CA

Practice address

323 Lincoln Blvd
Venice, CA 90291-2842

Phone

(310) 392-4103

NPI assigned

Jan 12, 2022

Last updated

Jan 12, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• UCLA Venice Clinical

  • General Practice Dentistry
  • Venice, CA
  • NPI 1932253184
  NPD (past)
• UCLA Venice Dental Center

  • Dental Clinic/Center
  • Venice, CA
  • NPI 1255465902
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641945600000",
    "number": "1609527670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1755 OCEAN AVE APT 510",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904013620",
            "telephone_number": "678-468-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 LINCOLN BLVD",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902912842",
            "telephone_number": "310-392-4103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMETREE",
        "first_name": "CARLETTA",
        "middle_name": "ANNYSE",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-12",
        "last_updated": "2022-01-12",
        "certification_date": "2021-12-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "107002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenny De Loera
• Wilhelmina Ramos Decastro
• Trysen Jason Del Bosque, PT, DPT
• Cesia Delacruz, LVN
• Mayra Alejandra Delgado Garcia
• Susan Derby
• Julie Derose
• Deuce Community, Inc.
• Theodore Kurt Dietz, ACSW
• Pamela Dirham, PH.D.

• Dentist in Venice, CA
• Providers in Venice, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.